Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period - a retrospective study of 372 pediatric patients from a single institution.

Objective: Common treatments for obstructive hydrocephalus caused by malignant midline intracranial tumors during the perioperative period include ventriculoperitoneal shunt (VPS) placement, endoscopic third ventriculostomy (ETV), and direct tumor resection. The purpose of this study is to determine whether it is necessary to treat hydrocephalus before tumor resection and to clarify which treatment is most effective.

Methods: Data from 372 pediatric patients (under 18 years) with obstructive hydrocephalus due to malignant midline intracranial tumors, referred to the Department of Pediatric Neurosurgery at Beijing Tiantan Hospital between January 2018 and September 2019, were collected. Their clinical features and outcomes were analyzed statistically.

Results: A total of 372 pediatric patients were treated for obstructive hydrocephalus. Of these, 215 patients underwent preoperative VPS placement; the success rate of preoperative VPS placement was 98.1% (211/215), with a mean recurrence duration of 63.5 ± 15.7 days. Forty patients underwent preoperative ETV; the success rate of preoperative ETV was 90.0% (36/40), with a mean recurrence duration of 53.8 ± 44.9 days. In total, 117 patients underwent direct tumor resection; the recurrence rate of hydrocephalus post-resection was 20.5% (24/117), with a mean recurrence duration of 125.0 ± 170.8 days. The recurrence rate of hydrocephalus in patients who required re-shunting after VPS placement was significantly lower than that in patients requiring re-shunting after ETV (p = 0.013).

Conclusion: Malignant midline intracranial tumors in pediatric patients often lead to obstructive hydrocephalus, and preoperative interventions, such as VPS placement, are more effective in reducing recurrence rates compared to direct tumor resection. VPS and ETV are both safe and effective treatments, with VPS showing a lower recurrence rate. The findings are primarily applicable to suprasellar, pineal, and fourth ventricular tumors, and further research is needed to explore hydrocephalus management in other midline tumor locations.